MEDICARE: DR. EDWARD H. PERKAL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21330	CA

General Provider Information

NPI Number	:	1972686897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD H. PERKAL D.D.S.

Provider Business Mailing Address
First Line	:	4200 N LAKEWOOD BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1558
Country	:	US
Telephone Number	:	562-420-1701
Fax Number	:	562-421-8447

Provider Business Practice Location Address
First Line	:	4200 N LAKEWOOD BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1558
Country	:	US
Telephone Number	:	562-420-1701
Fax Number	:	562-421-8447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	02/01/2012

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